New Algorithm for Estimating Insulin Doses Studied

A study published in the October issue of the journal “Diabetes Care” has demonstrated that, in patients with Type 1 diabetes who receive intensive insulin therapy through the use of a pump, a new algorithm based on the food insulin index is more effective at improving acute postprandial glycemia — or blood sugar levels after a meal — than a carbohydrate counting plan.

The study was headed by Jiansong Bao of the University of Sydney in Australia. Bao’s research team compared the effectiveness of a new food insulin index (FII) algorithm, which is used to estimate the dose of insulin that should be given at mealtimes, with counting carbs. The study consisted of 28 adult participants who had been diagnosed with Type 1 diabetes and were users of insulin pumps.

Study participants randomly ate two breakfast meals over the course of three consecutive days. The two separate meals were similar in factors such as total energy, fiber, glycemic index, and calculated insulin demand, but one meal had approximately twice the carbohydrate content of the other meal. For the meal with higher carbohydrate content, the proper insulin dose for the participants was determined by counting the amount of carbohydrates in the meal — 75g. On the other two mornings, participants received the less carb-heavy meal (41g carbohydrate) and used the new FII algorithm to determine proper insulin dosage. Researchers used continuous glucose monitors to determine postprandial blood sugar levels in the participants for the three hours following the meals.

Upon analyzing the results, the researchers discovered that the new FII algorithm had a significant effect in decreasing peak glucose excursion and glucose incremental area under the curve for the three hours after a meal. Participants spent significantly more time after a meal in normal blood glucose ranges when using the FII algorithm, although hypoglycemia was not significantly different between the two groups.

“An insulin algorithm based on physiological insulin demand evoked by foods in healthy subjects may be a useful tool for estimating mealtime insulin dose in patients with type 1 diabetes,” wrote the authors of the study.

Carbohydrate counting is a popular method of ensuring that insulin levels remain under control in both Type 1 and Type 2 diabetics, who must plan their meals to avoid excessive intake of carbohydrate in a single meal. Foods containing carbohydrates increase blood glucose levels, which can prove dangerous for diabetics. By planning their meals carefully and setting a maximum amount of carbohydrate in a single meal, diabetics can ensure that their blood sugar levels will remain well-managed. Most diabetics are advised to start at about 45-50 grams of carbohydrate per meal, though the number varies according to the plan of treatment and the severity of the disease. Doctors can help diabetics establish guidelines for the amount of carbohydrate they should be consuming at every meal.

Not only are diabetics advised to count carbohydrates to better manage blood glucose levels, but they can also use food nutrition labels to determine the total number of calories in the food and to avoid undesirable ingredients such as trans fats and saturated fats. Such fats are especially harmful to patients with heart disease or who are at risk for heart disease; doctors also advise against the consumption of excessive sodium, especially in those who are already hypertensive.